There is a paucity of information on what the combined effects of a disaster and living in a medically underserved rural area have on a vulnerable community's health, access to health resources, and quality of life. An attempt to capture the recovery piece of an already vulnerable community in the aftermath of a disaster only further serves to elucidate the grim landscape behind a medically underserved community. Attention is rarely drawn to the behind-the-scenes reality of post-recovery efforts within a fragmented community disproportionately suffering from pre-existing medical service delivery issues. This aspect of vulnerability is further exacerbated in the event of a disaster, but to our knowledge there has been little research documenting the effects of a disaster, particularly the "secondary surge" (e.g., the sudden increase in need for long-term health services following a disaster), on an already stressed community's health status and health care needs. The goal of this project is to use both qualitative and quantitative data collection and analysis, with community-based participatory research (CBPR), to document how the challenges presented by the post-disaster surge in health service delivery are further compounded within a medically underserved community in the rural South. To achieve this goal, we propose the following specific aims: 1) assess community members'perceptions about the long-term impacts of the disaster on public health, quality of life, and access to health services;2) assess healthcare providers'perceptions about the long-term impacts of the disaster on public health, quality of life, and access to health services;3) assess hospital discharge data (inpatient and emergency room) from area hospitals for utilization and severity and frequency of various diagnoses and procedures pre- and post-disaster. The project is novel because it will study the long-term health impacts of a chlorine spill in a small rural medically underserved area for the first time. The project is significant because information gained from the study may be used by federal agencies such as FEMA, EPA, and CDC to be more effective in their efforts to respond to disasters in both the initial stage and secondary surge. The research will address the gap in knowledge concerning a disaster's effects among area residents and improve understanding of how living in an area burdened by primary care service delivery issues may compound long-term recovery efforts. PUBLIC HEALTH RELEVANCE: There is limited information on how man-made disasters impact access to and utilization of health services and exacerbate health needs in medically underserved rural areas. This project is relevant to public health because it will provide evidence on how community members and health practitioners are impacted by disasters in medically underserved areas during the initial event and by the secondary surge of negative health outcomes and health care utilization. The results of this work will provide information gathered from community members and health care providers on how communities can be better prepared to deal with their health care needs after disasters.